Monthly Archives: July 2010

Why does every depressed person who poses for a picture assume some variation of this pose?

My move from veterinary clinical practice to public health practice wasn’t just a matter of changing a job. Working in clinics, I felt that working there was a danger to my well-being. Not so much my physical well-being, though I did get my share of bites and scratches, and when I was still working with large animals a well-placed kick could have landed me in the hospital. I’m speaking of our mental health, our sanity–our souls, if you will.

We may bring our own problems with us wherever we go, but environment, including career choice, may play a role as well. In other words, I was probably at least partially correct. It turns out that vets are 4 times more likely than the general population to commit suicide, and twice as likely as those in other health professions.

The news came out earlier this year in an article in the Veterinary Record, a British peer-reviewed veterinary journal. The article is titled Veterinary surgeons and suicide: a structured review of possible influences on increased risk. (Veterinarians are called veterinary surgeons in the UK).

Here’s the abstract:

Veterinary surgeons are known to be at a higher risk of suicidecompared with the general population. There has been much speculationregarding possible mechanisms underlying the increased suiciderisk in the profession, but little empirical research. A computerisedsearch of published literature on the suicide risk and influenceson suicide among veterinarians, with comparison to the riskand influences in other occupational groups and in the generalpopulation, was used to develop a structured review. Veterinary surgeonshave a proportional mortality ratio (PMR) for suicide approximately fourtimes that of the general population and around twice that ofother healthcare professions. A complex interaction of possiblemechanisms may occur across the course of a veterinary careerto increase the risk of suicide. Possible factors include thecharacteristics of individuals entering the profession, negativeeffects during undergraduate training, work-related stressors,ready access to and knowledge of means, stigma associated with mentalillness, professional and social isolation, and alcohol or drugmisuse (mainly prescription drugs to which the profession hasready access). Contextual effects such as attitudes to deathand euthanasia, formed through the profession’s routine involvementwith euthanasia of companion animals and slaughter of farm animals,and suicide ‘contagion’ due to direct or indirect exposure tosuicide of peers within this small profession are other possible influences.

From 1999-2006 “intentional self-harm,” known to the rest of us as suicide, was the 11th major cause of death in the United States. (It ranks much higher among the young, especially in the 15-24 year age category.) In high-income countries, the 3rd major cause of disease is depression. People struggling to survive in low-income countries, in spite of being at increased risk for other causes of disease, still carry a burden of depressive disorders that cause them to rank 7th overall as in causes of illness. However, you look at it, one’s own brain is capable of ruining or taking the life of the organism that supports it. This is not weakness, or a lack of character, any more than cancer is the moral fault of a person’s immune system to fail and recognize a danger created from within.

Or does it?

The American Dog Tick (only infects American dogs)

When I was a practicing vet, I saw how the medicine of fear works to beef up the wallets of practicing vets. As much as I like a meaty wallet, I found that hucksterism just isn’t my cup of suet. Am I being hyperbolic? Using too many high-cholesterol food metaphors? Probably. Also, working now in public health, I find that one of main jobs is to instill the proper amount of fear in the population at large.

What’s an appropriate amount of fear?

Why, what we in public health decide is appropriate!

Anyway, if you have a dog, or if you worry about the above vector-borne diseases, or if you have an interest in how medicine can be practiced when it’s just consumer and provider and no third-party payer, read my article from The Bark.

I received this question from Asia Kelly the other day:

Dr. Lerner, thank you for the informative post about Chagas disease. I am a biology student at the University of Texas Pan American in the Rio Grande Valley, South Texas. Last night I believe that I saw an “assassin bug” last night outside of my home near my front door. I am a little worried because I frequently sit outside at night on my porch and I get bitten by what I assumed to be ants or mosquitoes. I’m concerned that I may have been bitten by this insect. I’m wondering if the bite from that bug would cause a rash, swelling, or any sign that it has bitten me. I’m actually very concerned. Also, TV personality Dr. Oz said in a recent show that there is no cure or treatment and that most people will die from chagas in about 20 years. I’m interested in your opinion about this and I’d like to know of any information you might know about the prevelance of this disease in my area. I looked for your email on this site, but cannot find it. Thank you so much.

Ms. Kelly:

You would have to be extremely unlucky to get Chagas’ Disease in the United States. Although Trypanosoma cruzi, the parasite responsible for Chagas’ Disease does exist within our borders, there have only been 7 autochthonouscases, meaning cases acquired here. Admittedly, at least three of those cases were in Texas, but all of those cases were infants, which points out another reason why I don’t think that you are going to get Chagas’: Assassin (kissing) bugs are big bugs, around 2 cm in length. If one gets on you or bites you, you are likely to know it. You can get bitten in your sleep, but we have to remember that it is unlikely that the bugs are in your house. Typically, they live in the cracks in the walls of mud houses, between the bricks of unplastered walls, or in the fronds or thatch that are used for roofing. Some species live outside (like the North American species of triatomines), but these species–judging by the lack of autochthonous cases in the US–don’t seem to pose much danger.

Furthermore, remember that the infectious material is not the insect’s saliva, as it is with tick-borne or mosquito-borne diseases (like ehrlichiosis and West Nile Virus). The parasites are found in the feces of the assassin bugs. That means that if the insect doesn’t defecate while it bites you, it can’t infect. Apparently, the triatomines that we have here in the US don’t have that behavior.

So, while history has shown that it is possible to acquire Chagas’ disease in the US, it has also shown that it is extremely unlikely. Perhaps this will change, either to due to global warming, evolution, or the introduction of a competent vector–either inadvertently or intentionally–into the United States.

As far as vector -borne disease in the Rio Grande Valley go, I’d be more worried about those transmitted by mosquitoes. Dengue, for one, has reared its ugly head along this area, and will probably do so again.

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An Online Journal of Chagas’ Disease, Rabies, Beverages from South America, Dishes from the Sixties, and Other Public Health Issues

If you wish to read the Chagas' Disease primer in order, click here to go to Part 1 and follow the links.
We do not wish to diminish the importance of Chagas' disease, or make it seem that we are equating its significance with that of Pisco Sours or Inca Kola--we realize, alas, that for the most part only geeks and do-gooders are interested in diseases like Chagas'. We are hoping that by including matters of interest to the general public that we may attract more readers.

Richard Lerner

Richard Lerner is the author of this blog. All complaints should be sent to anyone other than him. We are looking for other writers interested in vector-borne disease, or timely information on the fight against these conditions, especially in the Americas.